Sciatica: What is the Source?

sciatica_legpainSciatica: What is the Source?

One of the most common things that I see in my office is Sciatica.  In fact, many patients come to their first visit and tell me straight away that they have sciatica.  Self diagnosis is common today as you can find anything you want on the internet.  However, what most people don’t understand is that sciatic symptoms can have multiple different causes.  This means that sciatica treatment can vary depending on the primary cause.  The real trick is to uncover the true source.  Is is stemming from poor soft tissue health in the low back?  Scar tissue build-up in the hips and glutes? Poor pelvis function?  Poor lumbar spine function?  A herniated disc in the lower back?  Poor postural position of the low back and pelvis?  Or more commonly, is it a combination of many of these?  Many times therapists take a cookie-cutter approach to sciatica.  Adjusting the lumbar spine and pelvis, stretches for the piriformis, and maybe some electrical stimulation to the area.  This can sometimes help overcome the pain and symptoms, but most of the times function is never addressed.  This is the real source of the problem.  Some dysfunction in postural positions or movement has taken place that led to the problem.  Unless this is addressed the problem is likely to return.

The other issue I see is that people many times have an MRI that is done because of nerve symptoms that are present.  While this is not a bad idea you always have to remember that the pain is not always caused by what is found in the MRI.  For example, if you take an MRI of someone’s low back, many times you are likely to find that is does not look perfect.  You may find some mild narrowing of spaces or even some mild disc bulging.  This does not mean that you can automatically assign these findings to the source of all the patient’s pain.  This is why many times surgery to the lumbar spine fails to resolve the patients complaints.  The surgeon did a great job at making the MRI look ‘normal’, but it may not have been the actual thing that was causing the symptoms in the first place.  In fact, in the vast majority of cases conservative care will be enough to take care of the symptoms and restore function without pain.  However, there needs to be a comprehensive approach to this care.  You must address the soft tissue health, the proper joint function, the nerve health, postural positions, strength capacity, AND movement patterns.  You cannot just pick one and roll the dice.  If you fail to correct postural and movement patterns then treatment will likely fail or the problem will shortly reoccur.  We see this many times in our office as patients come to us after numerous other practitioners have failed to resolve the problem.  This is not because they are bad at the services they provide, it is simply because they did not address all of the problems at the same time.

Understand the basic premise behind sciatica treatment is taking pressure off of the sciatic nerve, wherever the compression may be happening.  Whether this is caused by scar tissue, poor joint movement, or poor functional patterns, it doesn’t really matter.  All we have to do is uncover all the dysfunctions, restore normal function, and then let the body heal on its own.  If you are suffering from sciatica, just make sure that your sciatica treatment program is comprehensive and addressing all these areas to ensure you the best chance for success.

The Unseen Cause of Recurring Injuries

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The Unseen Cause of Recurring Injuries


For many years I have worked to help people overcome injuries and optimize their health.  For many people, these injuries need to be addressed quickly and efficiently so that training can continue and competitions can be completed.  As training intensity and duration increases the likelihood of injury also increases.  It is my job to eliminate as many of these ‘injury variables’ as possible.  This is why our assessments go way beyond just figuring out what hurts.  Uncovering the underlying causes for the injury becomes the real goal.  Some common causes for injury are poor mobility, poor movement patterns, weaknesses, and/or pure over-training.  However, sometimes I see clients who not only have areas that continue to get injured, but also have multiple areas throughout the body that are injured, swollen, and/or are chronically in pain.  When this occurs we have to start thinking outside the box.  For these clients, what undoubtedly needs to be considered is the possibility of some underlying systemic inflammation.  What this means is that there is something causing inflammation throughout the entire body that is really at the core of nagging, recurring injuries.  While recurring injuries can also be due to weakness, poor movement patterns, and/or strict overuse, it can also be due to a limited ability to fully recover.  This is where systemic inflammation plays a part.  This inflammation, even if low-level, can impede the body’s ability to recover completely.  And poor recovery equals a much higher incidence of re-injury.


There are really two common presentations that make me want to consider underlying systemic causes of inflammation.  The first, is when recurring injuries occur to the same area regardless of consistent treatment and proper function.  While this can simply be from continual overuse, systemic inflammation must also at least be considered as a reason for improper recovery and poor tissue health.  The area of injury is really just the ‘weak link’ that breaks down first when excessive inflammation is present.  Eliminating the cause of the inflammation can result in improved recovery, strength, and ability to handle training loads.


The second common presentation is when many areas throughout the body have low levels of pain.  These typically show up in joints.  So, for instance, if a client tells me that they hurt their hip and it is not getting better, but also proceed to tell me that both knees, right ankle, and many finger joints also hurt, I automatically start thinking systemic.  Having numerous areas of the body that are painful is difficult to explain away with simple mechanical issues.  Unless of course, they crashed their mountain bike or were involved in a motor vehicle accident.  However, barring any known massive trauma it is tough for numerous areas of the body, especially on opposite sides, to be explained purely from function.


Now the question really becomes, what areas need to be assessed if systemic inflammation is suspected?  This can be a little tricky, but with the proper questioning and a little digging it can be determined what areas may be necessary to test.  Some areas that can potentially cause systemic inflammation are poor diet, food sensitivities, poor gut health, parasites, bacterial overgrowth, yeast infections, hormone dysfunctions, and many others.  Having the ability to narrow this list down a little bit can be helpful so that proper testing can be ordered and underlying issues can be uncovered.  In my clinic, we use a wide variety of tests depending on what we are trying to assess.  The best part about many of these functional tests is that they are simple to do and most times can be done in the comfort of your own home.


The next level of thinking and true proactive healthcare, for either the office worker or the competitive athlete, is to always assess these underlying causes of inflammation as part of a standard assessment for overall health and prior to creating a comprehensive treatment plan.  Appropriately selected lab work can accurately assess many different systems in the body to check for inflammation itself, or for those things that we know create inflammation.  Treatment programs that miss this piece can many times prove ineffective or at the end be unable to completely resolve pain.  If this occurs, consider seeking out a professional who can assess these ‘other’ causes and get down to the root of the problem.


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Recovery: The Missing Link

recovery_nutrition_for_runnersRecovery:  The Missing Link

When someone is training, whether it be for an event or just to get in better shape, many hours are spent not only planning each days’ activities, but also in working towards a goal.  Most athletes spend most of their time making sure that they get enough training hours into each week.  A smaller number of athletes spend adequate time ensuring that their nutrition supports their training efforts (which is as equally important as the training itself).  However, very few athletes give enough attention and respect to one of the most important parts of training: Recovery.  Recovery is the glue that holds everything together.  Without this glue, areas in the body will gradually become dysfunctional and begin to fall apart.  Physical training, in any form, pushes the body to its limits.  This causes the body to breakdown as limits are surpassed and the athlete tries to make improvements; as muscles and other soft tissues are stressed, as in training, they essentially breakdown and cause micro-tears in the muscle fibers. After training, the body responds by building that tissue up stronger than before to support such efforts the next time.  This is how muscles become larger and performance is increased.  Now, what happens if you put your body through the same physical stress before it has had time to recover?  Essentially, you will be breaking down tissue that began the day at 90% instead of 100%.  This means that by the time you are done training you will have once again broken down the muscle tissue, but this time to a greater extent since you were not 100% at the start of training.  Now, the body is a remarkable machine that can adapt to many situations and learn to cope with many stresses.  By no means does this mean that you have to be 100% rested and fresh before each day of training.  However, if this scenario is repeated numerous times you can see how eventually the tissue will not be able to withstand the same levels of training.  Soon the tissue will be starting the days’ training at 20% and little work can be done before the tissue fails and injury occurs.  Recovery is a complex puzzle that requires more than just a little time off.  Understanding the importance of recovery and how to implement it correctly into your training plan will not only boost performance, but it will keep you active and injury free.  In my many years of clinical practice I have seen numerous athletes competing in a wide variety of recreational and professional sports.   Those who pay attention to the various parts of recovery almost always do better in competition.  There is a simple reason for this: improved recovery = an increased ability to train harder = better results!  In my opinion, the success rates of training programs hinge on the things done when you are not actually training!

Cannons and Canoes


Cannons and Canoes

One of my favorite quotes as it relates to power creation in the human body I read many years ago in Stuart McGill’s “Ultimate Back Fitness and Performance”. When speaking about how the body can generate the most power the book says, “You can’t fire a cannon from a canoe”. This image has stuck with me ever since I first read it and seems to simply explain how we need to address the athlete’s conditioning if we want to ultimately create maximum power. The absolute, crushing power of a cannon ball shot from a cannon is unmistakable. If you decided one day that you wanted to create a cannon with more power that could ultimately create more force, the first instinct would be to build a bigger cannon that used a bigger cannon ball. This is often the same instinct that we have as athletes when it relates to our sport. Getter faster on the bike means getting a better bike, a lighter shoe, a lighter wheel, or more aerodynamic frame. To get faster, runners want to get the best shoe and just run more miles. To get bigger muscles athletes think only to lift heavier weights and lift them more often. While all of these things do help to improve the performance of the athlete, the most important piece of equipment is often neglected: the body.
Let’s look back at our example of the cannon. What if all the focus was placed on building a bigger cannon and heavier cannon ball without paying much attention to the stability of the cannon. This is eloquently illustrated by thinking about firing a cannon from a canoe. If you put a powerful cannon on a canoe and fired it, the explosion would cause more energy displaced in the movement of the canoe rather than in the propulsion of the cannon ball. This same principle can be seen with athletes. Too often athletes are narrowly focused on big muscles and better gear, rather than focusing on the stability of their cannon. Remember that the more you stabilize the cannon, the more power you can create when shooting the cannon ball. Any loss in the stability of the cannon directly relates to loss of power in the firing of the ball. This is no different than the human body. If athletes lack proper stability then maximum power can never be created. This goes for every sport: golf, running, cycling, basketball, football, etc. Taking the cannon off of the canoe and putting it on the ground obviously yields better results. For the highly competitive athlete this needs to be taken one step further. Not only does the cannon need to be on solid ground, but it needs to be completely immobilized so that no energy is wasting moving the cannon when fired. This ultimate stability of the cannon allows for maximum force dispersed to the cannon ball.
For the athlete, this ultimate stability needs to be realized not only through the proper fitness training, but also through optimizing the stability of the internal health. Let’s briefly discuss these two:
Proper fitness training for the athlete needs to be very specific to what muscles and movements are involved in the sport. It also needs to build an athlete from the ground-up. This means making sure there is a proper base strength and muscular control from which power and strength can be built upon. It is far too common to see athletes who focus on power and strength, but have very poor stabilizing capacity and fine motor control.
Optimizing internal health is probably never even considered by the athlete as a way to ‘stabilize the cannon’. This is where I find true performance enhancement can really be achieved. Getting bigger, stronger, or faster is completely determined by an athletes ability to recover. This was discussed at length in a previous blog (read here: so we’ll keep it simple here. Just know that improving your overall health is the absolute best way to be able to train harder and recover faster. Using specified lab work, precise nutritional intervention, and high-quality supplementation can give athletes huge advantages in competition.
If you are a serious athlete that either wants to compete at a high level or stay in the sport for many years, start to consider that optimizing your health is the first priority to achieving those goals.

Running Linked to Lower Arthritis

A recent, large scale study has shown that running is actually linked to lower arthritis rates than walking.  This study, performed by Paul Williams, Ph.D., analyzed 74,752 runners along with 14,625 walkers and was published in the journal Medicine & Science In Sports & Exercise.  The results surprised even those analyzing the data.  First, it showed that runners had approximately half the risk of osteoarthritis and hip replacement as walkers.  This goes completely against the theory that running is ‘bad for your knees and hips”.  As far as scientific studies go, a 50% differential when comparing two groups is MASSIVE and very significant.

The second major finding came when the author separated runners into categories based on average mileage per week.  The groups were divided into 7, 7-14, 4-21, and 21+ miles per week.  Again, contrary to common belief he found that those who did more than 7 miles per week had a 15-18% reduction in osteoarthritis and 35-50% reduction in hip replacements.  If running itself was so bad for the knee and hip joints this finding would be completely reversed.  It is impossible to know exactly what the reasons were for these shocking results.  However, it can probably be assumed that those who consistently run are overall healthier individuals with an assumed lower BMI (Body Mass Index).  Excess weight can be a large factor in the development of osteoarthritis as the joints are under too much stress.  Running is a great way to burn calories, lose weight, and stay in good shape which would place less overall stress to the joints all day long.  Running also puts force through the joints and in return causes the body to strengthen the bones and cartilage for such demands.

However, the benefits go beyond just reduction in weight and stronger bones.  Running is one of the best cardiovascular exercises that you can perform.  It makes the heart strong and allows the body to become accustomed to handling strenuous tasks.  And as cardiovascular disease is the #1 killer in society today it seems wise to want a strong heart.

Running also helps to boost metabolism, increase the production of endorphins, and is a great way to relieve stress.  In fact, the number of benefits to running are numerous.  The main objection to running for many in the medical field was the assumed damage happening to your joints.  However, with this study we can now see that those assumptions are just not valid.  This is not to say that running is not strenuous to the body, but so is any exercise.  In my opinion, the benefits far outweigh any potential negatives and the rationale to not run because ‘it is too hard on the body‘ is just silly.  Now, we have some literature to back it up.

As a chiropractor, and one who analyzes people heavily on function, it is obvious to see that if joints are misaligned then stress to certain joints will be excessive.  If the joints in your pelvis or low back are misaligned or not moving correctly then the hips and legs are forced to move abnormally to compensate.  Over time, this dysfunction can definitely create osteoarthritis and speed up its development.  It is exactly like the alignment on your car.  If your cars alignment is off, the tires wear down much faster in certain spots.  Your body  does the same and develops osteoarthritis from excessive, asymmetrical wear.  Keep the body functioning properly and it should be able to handle things such as running with no problem.